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Bonds of Love

"So live your life that the fear of death can never enter your heart. Trouble no one about their religion; respect others in their view, and demand that they respect yours. Love your life, perfect your life, beautify all things in your life. Seek to make your life long and its purpose in the service of your people. Prepare a noble death song for the day when you go over the great divide. Always give a word or a sign of salute when meeting or passing a friend, even a stranger, when in a lonely place. Show respect to all people and grovel to none. When you arise in the morning give thanks for the food and for the joy of living. If you see no reason for giving thanks, the fault lies only in yourself. Abuse no one and nothing, for abuse turns the wise ones to fools and robs the spirit of its vision. When it comes your time to die, be not like those whose hearts are filled with the fear of death, so that when their time comes they weep and pray for a little more time to live their lives over again in a different way. Sing your death song and die like a hero going home"

Chief Tecumseh (Crouching Tiger) Shawnee Nation 1768-1813

I was doing the on calls during the Christmas week because I had to come home the following weekend.

Abdulla ( Not his real name) was brought in on Thursday night through the ER. He looked around forty years old and had severe shortness of breath. Through the middle of his struggle for air, he said it was just few days that he was feeling unwell. He had gone to Bangkok for a medical check up and just come back a week back and the doctors there had told him that “everything is fine, and there is no need to go back”. I asked him if he had any medical report with him and he said, “My doctor had gone on vacation and would send it once he is back”

The x ray chest showed he had massive fluid collection in his right chest. I shifted him to the ICU because his oxygenation was dropping. We did an immediate aspiration to remove the fluid and drained a litre and half of bloody fluid. One look at the nasty looking fluid, and I knew this was no ordinary infection, and must be cancerous. But Abdulla was confident. His wife and young son were around. He was relieved of his distress once the fluid was removed and was talking cheerfully to his family and asked his son to go home and bring his favourite food.

The next day we did a CT scan of the chest and found he had a large tumour in the lung. He also had operation marks on his chest, and the films had shown that they had resected some ribs from his chest. Everything put together was clear. I suggested a CT guided biopsy and he refused outright. By the third day he was comfortable and during rounds, he asked me permission to go home. I explained the condition to him and the need to do further tests. His family was outside the ICU. He smiled at me and took an envelope from under his pillow and handed it over to me. There was a detailed medical report stating that he had advanced cancer which was inoperable and resistant to all the chemotherapies they had tried on him. He only had limited time. He had prevented his doctor from disclosing the diagnosis to his family, giving in writing that he was taking all the responsibilities on himself.

Finally, he smiled at me and said’ Doctor, I knew from the beginning you had guessed it. Both of us know now. I know I don’t have much time left. But I want my family to be at peace till the inevitable. Isn’t that reason enough?”

Medicine exists to fight death and disease, and that is, of course, it’s most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. I agreed to what all he asked for.

I have seen many terminally ill patients during my career. But not a single one like him. He had tremendous guts. And a concern which is rare these days. I realised how sincerely he loved his wife and son. Love, is not only in taking, it is more in giving.

For the bonds of love are enduring and cannot be severed by death. This is the ultimate comfort in the presence of death and dying – that the bonds of love can grow roots within the heart itself, and once implanted there, are able to remain forever.

Comments

I can imagine the scene! We all talk about facing death bravely, but what would it be when it finally comes? Yet, even if I got scared, i don't think there is anything to be ashamed. That's the way I am. Some are fortunate, like Abdullah.

He is indeed a brave soul and keeping it from his family has to be hard on him. I had a brother-in-law that had cancer in his shine bone and he did not tell anyone about it. It was so devastating on us when he died, he was such a wonderful person and the father of eight, most of them grown. To face death and know you will not win comes to us all. I think the worst is when one passes away in the blink of an eye, no one is prepared for that. Have a nice week.

Did he come back yet? I dont know Dr.Anthony, I mean, he loves his wife, its very evident here but I am concerned for his wife. Obviously she must be deeply in love with him too. If my husband (God forbid) even has a cold, I would want to know. To each their own but I hope this doesnt shatter his wife when she comes to face the reality by herself.

death...a great teacher....sometimes it changes rather encourages its victim ...sometimes it changes the mental approach of their witness altogether towards life.in this person case the idea of death got mixed with his innate courage and gave him strength .my mother's death made me strong....no doubt one's own nature plays an important role while confronting death...but i believe death itself has some charisma it brought tremendous changes.

I truly admire his strength and also appreciate your take on it. Sometimes it is the doctors who hold the patients back in the hospitals - in fear of later retaliation by the family members. At least that's the case here in the US.

@BalachandranThe truth is that we do not know much about 'after death'.If we had an assurance of a life in paradise where milk and honey flows,options would be for sure.@margaretThat is a real valid issue.If we expect something bad to happen,probably acceptance would be easier.Otherwise,it might become a shocking experience.But anyone with common sense would understand what has been happening and going on.It is impossible to hide truth for long.@RachnaDeath is simply a mystery.@InsigniaIt is a mind set.Probably that is his nature.He would probably make such kind of decisions all through life.@AlkaSorry to know about your father.Doctors get used to such events,and over time develop some kind of numbness.They can see death as something inevitable and accept it as such.@RGBYes,Dont know how long it can be kept secret. There will come a time,when he deteriorates and no longer in charge of situations,the treating doctor would discuss with the family.@BKCTrue.They make life easier for others.@A Glad you liked it.Life is full of unexpected.@MadhuHe didnt come back yet.Our hospital is near his home.He would go to a distant hospital,making it difficult for his family to reach him.That was what he did all along.He would be brought in,for sure.@Heavenly MuseWe all learn from experiences,and we should.Our responses are all part of our inherent personality.@AnilWell said." I am the master of my fate".I wish we could all sing that.There are weak hearted too,who believe in destiny.@RadhaHe has a young son,who appears so insensitive,or I dont know if he was acting.But one day,I am sure they have to deal with the truth.

Such a wonderfully thought-provoking post. My nana knew she was dying and yet chose to keep it from us. We, her family, somehow sensed she was dying and yet no-one ever spoke of it. Brave and caring of her to spare her family in such a way? Certainly. But I can't help but feel it must have been lonley for her at times though as Keats, above, points out, how each of us face death is a unique thing, much dependent on personality.

Very well narrated..Doc whenever I read your blog its under absolute silence Coz one or the other thing is very interesting...Docs are angels..I really salute this noble profession..where they go through life and death everyday,with patience and all emotions..God Bless!

@AnilSharp memory.you dont forget a thing!@KeatsTrue.For for someone who is mentally prepared to go through the ordeal,it could be a different choice.@PettyYes,it is part of personality and attitude.I have seen many who cry out and complain about each and everything and trying to put the blame on others.That is another way of dealing with it!@JayThat is why I suggest to many bloggers to visit you,find something good to eat when they can.@HarmanThose were really kind words.Every profession has its duties and responsibilities.I think these days the one to one relationship between the doctor and the patient is going downhill.@Happy KittenI am really sorry to hear the sad news.I know how difficult it is to go through it.As silent witnesses watching helpless. I tried to find your mail id to write you something.Could you send it to me?@ElizabethI thought of sharing some personal experiences for a change.

Its very brave of him to hide it from his wife..but sometimes sharing is also good,as the other person slowly gets prepared for the calamity, whereas a sudden death impacts a lot.and then his wife will always have a regret..only if I knew.as she also would have liked to hundred things for him.

Internist Physician.
Life has been a very bumpy ride, so I could teach others how to ride safe.I cannot believe that the purpose of life is to be just happy. It is to be useful, to be responsible, to be compassionate and above all, to stand for something, to have made some difference that you lived at all.